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Pathoma GI > 11.8 Colon > Flashcards

11.8 Colon Flashcards

1
Q

Defective relaxation and peristalsis of rectum and distal sigmoid colon

A

Hirschsprung disease

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2
Q

Hirschsprung association

A

Down syndrome

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3
Q

Plexus b/t IC and OL muscle layers of the muscularis propia that regulates motility

A

Myenteric (Auerbach)

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4
Q

Plexus in the submucosa that regulates BF, secretions, and absorptions

A

Submucosal (Meissner)

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5
Q

What causes Hirschsprung?

A

Failure of neural crest derived ganglion cells to descend into myenteric and submucosal plexus

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6
Q
  1. Failure to pass meconium
  2. Empty rectal vault on digital rectal exam
  3. Massive dilatation of bowel proximal to obstruction w/ risk for rupture
A

Hirschsprung

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7
Q

Hirschsprung rectal suction biopsy reveals

A

lack of ganglion cells

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8
Q

Tx Hirschsprung

A

Resection of the involved bowel (ganglion cells present proximal to diseased segment)

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9
Q

Outpouchings of mucosa and submucosa through the muscularis propria in colon (false diverticulum)

A

Colonic diverticula

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10
Q

Risk factors for colonic diverticula are related to wall stress

A
  • constipation
  • straining
  • low fiber diet
  • age (more common in older adults)
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11
Q

Where are colonic diverticula most commonly located?

A

where the vasa recta traverses the muscularis propia (weak point in colonic wall) most commonly in the sigmoid colon

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12
Q

Complications of colonic diverticula (though usually asymptomatic)

A
  1. Rectal bleeding (hematochezia)
  2. Diverticulitis
  3. Fistula
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13
Q

Presents with appendicitis-like symptoms in the LLQ

A

Diverticulitis (due to obstructing fecal material)

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14
Q

Inflamed diverticulum ruptures and attaches to a local structure; e.g. may present with air or stool in urine

A

Colovesicular fistula

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15
Q

Acquired malformation of mucosal and submucosal capillary beds

A

angiodysplasia

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16
Q

where does angiodysplasia usually arise?

A

cecum and righ colon due to high wall tension

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17
Q

rupture of angiodysplasia presents as

A

hematochezia in an older adult

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18
Q

AD disorder resulting in thin-walled blood vessels, especially in the mouth and GI tract; rupture presents as bleeding

A

Hereditary hemorrhagic telangectasia

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19
Q

Ischemic damage to the colon

A

ischemic colitis

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20
Q

most common location for ischemic colitis

A

splenic flexure (watershed area of SMA)

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21
Q

most common cause of ischemic colitis

A

atherosclerosis of SMA

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22
Q

ischemic colitis presentation

A

postprandial pain and weight loss

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23
Q

ischemic colitis –> infarction –> [presents as]

A

pain and bloody diarrhea

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24
Q

relapsing abdominal pain with bloating, flatulence, and change in bowel habits (diarrhea or constipation) that improves with defecation; classically seen in middle-aged females

A

Irritable bowel syndrome (IBS)

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25
Q

IBS is related to [cause]

A

disturbed intestinal mobility; no identifiable pathologic cahnges

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26
Q

what may improve IBS symptoms?

A

increased dietary fiber

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27
Q

raised protrusions of colonic mucosa

A

polyps

28
Q

two types of colon polyps

A

hyperpalstic and adenomatous

29
Q

polyps due to hyperplasia of glands; classically shows a serrated appearance on LM; most common

A

hyperplastic polyp

30
Q

polyps due to neoplastic proliferation of glands; less common

A

adenomatous

31
Q

hyperplastic polyps usually arise in the

A

left colon

32
Q

benign polyp with no malignant potential

A

hyperplastic

33
Q

benign, premalignant polyp (may progress to adenocarcinoma via adenoma-carcinoma sequence)

A

adenomatous

34
Q

adenoma-carcinoma sequence describes the progression from normal colonic mucosa to

A

adenomatous polyp to carcinoma

35
Q

three mutations in the adenoma-carcinoma sequence

A

APC, K-ras, p53

36
Q

mutation (sporadic or germ line) that increases risk for formation of polyp

A

APC

37
Q

mutation that actually leads to formation of polyp and increases its size

A

K-ras

38
Q

mutation that allows for progression of adenomatous polyp to carcinoma

A

p53, requires increased COX expression

39
Q

how to impede adenoma-carcinoma sequence?

A

ASA

40
Q

risk for adenomatous polyp –> carcinoma is related to

A

size (>2 cm),
sessile growth,
villous histology

41
Q

AD disorder characterized by 100s to 1000s of adenomatous colonic polyps

A

FAP

42
Q

FAP due to mutation in

A

APC (chromosome 5)

43
Q

Prophylactic treatment in FAP

A

remove colon and rectum (o/w almost all pts develop carcinoma by 40)

44
Q

FAP with fibromatosis and osteomas

A

Gardner

45
Q

non-neoplastic proliferation fo fibroblasts; arises in retroperitoneum (desmoid) and locally destroys tissue

A

fibromatosis

46
Q

benign tumor of bone that usually arises in skull

A

osteoma

47
Q

FAP w/ CNS tumors (medulloblastoma and glial tumors)

A

Turcot syndrome

48
Q

sporadic, hamartomatous (benign) poly that arises in kids < 5yo; usually presents as solitary rectal polyp that prolapses and bleeds

A

Juvenile polyp

49
Q

characterized by multiple juvenile polyps in stomach and colon; large #s inc. risk of carcinoma

A

juvenile polyposis

50
Q

Hamartomatous (benign) ploys throughout GI tract and mucocutaneous hyperpigmentation (freckle-like spots) on lips, oral mucosa, and genital skin; AD

A

Peutz-Jeghers Syndrome (AD)

51
Q

Peutz-Jeghers increases risk for

A

colorectal, breast, and gynecologic cancer

52
Q

most common pathway for colon cancer

A

adenoma0carcinoma sequence

53
Q

second molecular pathway for colon cancer

A

microsatellite instability

54
Q

repeating sequences of noncoding DNA; integrity of sequence (stability) is maintained during cell division

A

microsatellites

55
Q

microsatellite instability indicates

A

defective DNA copy mechanisms (e.g. DNA mismatch repair)

56
Q

HNPCC is due to inherited mutations in

A

DNA mismatch repair

57
Q

HNPCC increases risk for

A

colorectal, ovarian and endometrial cancers

58
Q

De novo colorectal carcinoma (not from adenomatous polyp) at young age; usually right-sided

A

HNPCC

59
Q

screening for colorectal carcinoma

A

colonoscopy and fecal occult blood testing; begins at 50

60
Q

Older adult with iron-deficiency anemia

A

colon cancer (right sided)

61
Q

colon cancer that grows as napkin-ring lesion; presents with decreased stool caliber, LLQ pain, and blood-streaked stool

A

Left-sided

62
Q

colon cancer that grows as a raised lesion; p/w iron-deficiency anemia (occult bleeding) and vague pain

A

Right-sided

63
Q

Strep bovis endocarditis =

A

colon cancer

64
Q

colon cancer most commonly metastasizes to the

A

liver

65
Q

CEA is a serum tumor marker that is useful for

A

assessing treatment response and detecting recurrence, not for screening

66
Q

most common location for left-seed colon cancer

A

rectosigmoid colon

Pathoma GI (8 decks)

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